Prevalence and Clinical Significance of Diabetes in Asian Versus White Patients With Heart Failure
The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to...
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| Published in | JACC. Heart failure Vol. 5; no. 1; pp. 14 - 24 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2213-1779 2213-1787 2213-1787 |
| DOI | 10.1016/j.jchf.2016.09.015 |
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| Abstract | The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction.
Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world’s diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients.
Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms.
Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045).
Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications.
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| AbstractList | Abstract Objectives The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Background Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world’s diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. Methods Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. Results Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045). Conclusions Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; p = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; p = 0.045). Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. OBJECTIVES The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. BACKGROUND Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the worlds diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. METHODS Two contemporary population-based HF cohorts were combined: from Singapore (n 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n =19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. RESULTS Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p amp;lt; 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45;. 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; P-interaction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; P-interaction = 0.045). CONCLUSIONS Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. (C) 2017 by the American College of Cardiology Foundation. The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world’s diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045). Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. [Display omitted] The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction.OBJECTIVESThe study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction.Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients.BACKGROUNDDiabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the world's diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients.Two contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms.METHODSTwo contemporary population-based HF cohorts were combined: from Singapore (n = 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n = 19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms.Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045).RESULTSDiabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p < 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45; 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; pinteraction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; pinteraction = 0.045).Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications.CONCLUSIONSDiabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. |
| Author | Bank, Ingrid E.M. Dahlström, Ulf Gijsberts, Crystel M. Yeo, Poh Shuan Daniel Leong, Gerard K.T. Lam, Carolyn S.P. Jaufeerally, Fazlur Teng, Tiew-Hwa K. Lund, Lars H. Sim, David Benson, Lina Ling, Lieng H. Richards, A. Mark Ong, Hean Yee de Kleijn, Dominique P.V. |
| Author_xml | – sequence: 1 givenname: Ingrid E.M. surname: Bank fullname: Bank, Ingrid E.M. organization: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands – sequence: 2 givenname: Crystel M. surname: Gijsberts fullname: Gijsberts, Crystel M. organization: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands – sequence: 3 givenname: Tiew-Hwa K. surname: Teng fullname: Teng, Tiew-Hwa K. organization: National Heart Center, Singhealth, Singapore – sequence: 4 givenname: Lina surname: Benson fullname: Benson, Lina organization: Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden – sequence: 5 givenname: David surname: Sim fullname: Sim, David organization: National Heart Center, Singhealth, Singapore – sequence: 6 givenname: Poh Shuan Daniel surname: Yeo fullname: Yeo, Poh Shuan Daniel organization: Department of Cardiology, Tan Tock Seng Hospital, Singapore – sequence: 7 givenname: Hean Yee surname: Ong fullname: Ong, Hean Yee organization: Department of Cardiology, Khoo Teck Puat Hospital, Singapore – sequence: 8 givenname: Fazlur surname: Jaufeerally fullname: Jaufeerally, Fazlur organization: Department of Medicine/Cardiology, Singapore General Hospital, Singapore – sequence: 9 givenname: Gerard K.T. surname: Leong fullname: Leong, Gerard K.T. organization: Department of Cardiology, Changi General Hospital, Singapore – sequence: 10 givenname: Lieng H. surname: Ling fullname: Ling, Lieng H. organization: Yong Loo Lin School of Medicine, National University, Singapore – sequence: 11 givenname: A. Mark surname: Richards fullname: Richards, A. Mark organization: Cardiovascular Research Institute, National University, Singapore, Singapore – sequence: 12 givenname: Dominique P.V. surname: de Kleijn fullname: de Kleijn, Dominique P.V. organization: Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands – sequence: 13 givenname: Ulf surname: Dahlström fullname: Dahlström, Ulf organization: Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden – sequence: 14 givenname: Lars H. surname: Lund fullname: Lund, Lars H. email: lars.lund@alumni.duke.edu organization: Department of Medicine and Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden – sequence: 15 givenname: Carolyn S.P. surname: Lam fullname: Lam, Carolyn S.P. email: carolyn.lam@duke-nus.edu.org organization: National Heart Center, Singhealth, Singapore |
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| Copyright | 2017 American College of Cardiology Foundation American College of Cardiology Foundation Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
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| Keywords | global health NYHA EF OR global disease patterns CI CAD diabetes mellitus HR HFpEF IQR HFrEF heart failure with preserved ejection fraction NT-proBNP heart failure with reduced ejection fraction HF BMI coronary artery disease ejection fraction interquartile range odds ratio New York Heart Association heart failure body mass index hazard ratio confidence interval N-terminal pro–B-type natriuretic peptide |
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| Snippet | The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure... Abstract Objectives The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients... OBJECTIVES The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with... |
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| SubjectTerms | Cardiovascular diabetes mellitus global disease patterns global health heart failure with preserved ejection fraction heart failure with reduced ejection fraction |
| Title | Prevalence and Clinical Significance of Diabetes in Asian Versus White Patients With Heart Failure |
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